Tools used to measure maternal outcomes.

BackgroundPreventing Adverse Childhood Experiences (ACEs) is a public health priority, and the perinatal period is a sensitive life stage when preventive interventions could be particularly effective. Protecting and buffering pregnant persons and infants from exposure to adversity can optimize children’s development and health trajectories, reduce future morbidity and mortality, and even break intergenerational cycles of adversity, but no study has synthesized experimental evidence on effectiveness of interventions to address ACEs in the perinatal period.ObjectivesTo (1) identify perinatal ACE prevention interventions, tested in high quality randomized control trials, with a dyadic perspective examining outcomes for mother and child; (2) describe their (a) place on the public health prevention continuum and (b) incorporation of life course characteristics that aim to optimize life health trajectories; and (3) determine which interventions show evidence of effectiveness.MethodsWe undertook a scoping review, using a modified PRISMA-Sc approach, of articles published in English between January 2000 and November 2023 identified through Psych info and PubMed using search terms for a broad range of adversities, with additional capture of articles from relevant reference lists. Interventions were included if they targeted an identified ACEs exposure or risk; were tested in randomized controlled trials (RCTs); reported outcome measures for both mother and child and were initiated during pregnancy. Interventions were further analyzed using the public health prevention continuum and Life Course Intervention Research (LCIR) characteristics frameworks. A two-tailed t test was used to ascertain the association between LCIR characteristics, and the outcomes achieved.ResultsOf 2148 articles identified, 57 were in scope for detailed analysis, yielding 53 unique interventions. Overall, 42 (74%) reported some positive impact; 37 (65%) for mothers; 37 (65%) for the child, and 32 (56%) for both. Interventions with the strongest evidence based on study quality and reported outcomes were co-parenting programs designed to improve the quality and function of the co-parenting relationship, home visiting interventions, and integrative health interventions incorporating baby massage and/or yoga. Half of effective interventions were secondary prevention focused. The mean number of life course characteristics was significantly higher in the studies that reported a positive impact on the mother and/or child (p = 0.003).ConclusionsFew studies specifically addressed ACEs as a defined set of adversities, yet a range of perinatal interventions showed positive impacts on individual ACE risks or exposures. Intentional incorporation of life course characteristics and bundling of evidence-based components into comprehensive perinatal interventions hold promise for future ACEs prevention.

背景 预防不良童年经历（Adverse Childhood Experiences, ACEs）是公共卫生领域的优先事项，而围产期是预防干预措施可能尤为有效的敏感生命阶段。对孕妇及婴幼儿加以保护、使其免受逆境暴露，可优化儿童的发育与健康轨迹，降低未来的发病率与死亡率，甚至打破逆境的代际循环，但目前尚无研究对围产期针对ACEs的干预措施有效性的实验证据进行综合梳理。
研究目标 本研究旨在：（1）识别经高质量随机对照试验（Randomized Controlled Trials, RCTs）验证的围产期ACEs预防干预措施，采用二元视角分析母婴双方的结局指标；（2）阐述此类干预措施（a）在公共卫生预防连续体中的定位，以及（b）纳入的旨在优化生命健康轨迹的生命历程特征；（3）明确哪些干预措施具备有效性证据。
方法 本研究采用改良版PRISMA范围综述（PRISMA-Sc）方法，对2000年1月至2023年11月间发表的英文文献开展范围综述。文献通过PsycINFO与PubMed数据库检索，检索词覆盖各类逆境相关主题，并补充纳入来自相关参考文献列表的文献。纳入的干预措施需满足以下条件：针对已明确的ACEs暴露或风险因素；经随机对照试验验证；同时报告母婴双方的结局指标，且干预于妊娠期启动。随后，采用公共卫生预防连续体框架与生命历程干预研究（Life Course Intervention Research, LCIR）特征框架对纳入的干预措施进行进一步分析。采用双侧t检验，以明确LCIR特征与研究所获结局之间的关联。
结果 本研究共检索到2148篇文献，其中57篇符合详细分析的纳入标准，涵盖53项独特的干预措施。总体而言，42项（74%）干预措施报告了一定的积极影响；其中针对母亲的有37项（65%），针对儿童的有37项（65%），同时覆盖母婴双方的有32项（56%）。基于研究质量与报告结局的证据强度最高的干预措施包括：旨在提升共同养育关系质量与功能的共同养育项目、家庭访视干预，以及纳入婴儿按摩和/或瑜伽的整合式健康干预。半数有效干预措施属于二级预防范畴。在报告对母亲和/或儿童产生积极影响的研究中，生命历程特征的平均数量显著更高（p=0.003）。
结论 目前仅有少数研究将ACEs作为一组明确的逆境类型开展针对性研究，但已有一系列围产期干预措施对个体ACEs风险或暴露情况产生了积极影响。有意识地纳入生命历程特征，并将循证组成部分整合为综合性围产期干预措施，有望为未来的ACEs预防工作提供可行方向。